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The art of dying

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Losing a loved one is one of the hardest things to experience in life. All signs may indicate that the end of a life is near, yet it is so hard to accept them.

Most typically, people experience the death of parents late in life. There are exceptions of course. Tragic accidents or fatal diseases intervene with the normal cycles of life. For those experiences, the principle need is to focus on coping strategies. Helping people when the shock of death comes too early is a profound challenge. Every single circumstance is different.

But there are some commonalities we all share when it comes to aging parents or grandparents. We know they are not going to live forever. We sometimes see the decline, yet focus on the good signs and hope the bad things hold off as long as they can.

Triggers

Often there is some incident that triggers the process toward actual death. It may be some shift in health such as a heart issue or surgery. Yet something as simple as a fall can undermine a person’s health.

Recently that happened to a close associate of mine. His mother fell in the middle of the night and her equally aged husband did not notice. What followed was a series of stays in different hospital facilities and nursing homes.

There is a harsh reality afoot with people very aged and in a severe state of decline. Hospitals are chartered to help people get better. They reserve the right to determine if that is happening. There are broad patterns that affect these decisions. People experienced with the dying come to recognize whether the trend is toward better health or whether the symptoms of an accident or illness are likely insurmountable.

The protocols of this decision-making can seem confusing to family members or those chartered with caregiving. The legality of prescribing certain medications, for example, is often determined by the prognosis issued by the presiding physician.

Free radicals

Then there are the more radical decisions to consider. Will a surgery help mom or dad survive longer, or is it just a desperate attempt to extend their life?

Meanwhile, the patient sometimes vacillates between wanting all that rigamarole and perhaps not putting up with the intrusions. This can seem like they are giving up, or losing hope. But in truth, some people come to grips with their situation faster than their caregivers.

Yet that’s not often the case with people suffering pain. Their decision-making abilities are directly affected by their pain tolerance. That’s where it gets difficult for the hospital or other facilities to make decisions that please the family. Either the patient gets so doped up from painkillers and can’t converse, or they grow agitated from lack of treatment and just want the pain to end. Even death becomes a desirable option.

Opponents

There are relationship issues to confront as well. A temperamental parent can be a daunting opponent when it comes to end-of-life decision-making. If there are unresolved or dysfunctional relationship issues between parent and child or siblings, the end-of-life process can become complex and tense. Blame gets tossed around. Insinuations made. Guilt enters the picture. No one can find peace or balance. The parent becomes Ground Zero for family conflict.

Usually, there’s one sibling or one person that does most of the steering through an end of life journey for a parent or grandparent. Yet that leadership role can generate friction too. It can happen that parents will play one sibling off the other in order to gain sympathy or hedge the bets. When those parallel decisions work against the medical advice of the presiding doctor and the presiding sibling, things can get really confusing. Or angry.

Palliative care versus hospice

Sometimes medical staff will seek out the primary decision-maker(s) for discussions about palliative care or even hospice. Palliative care is defined as follows: a multidisciplinary approach to specialised medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis. The goal of such therapy is to improve quality of life for both the patient and the family.

But quite frequently, palliative care has the goal of keeping the patient comfortable leading up to the actual process of death. When death is likely imminent due to any number of signs related to disease or debilitation, a transition to actual hospice care occurs.

Hospice removes most life-giving supports and acknowledges that the patient is indeed dying. This can be an extremely challenging decision for families to make. But there are good reasons why hospice is entered as a care strategy.

Experience

Having worked with both my parents and my wife in both palliative and hospice care situations, I can assure you that the differences are not so distinct or profound as they might seem. I am fairly convinced that the only reason the terms differ is to ease the transition for family members. The term palliative is designed to help them come to terms with the fact that their loved one is indeed dying. When the wise female physician pulled me aside the day my wife was unable to move from the table where she lay, and counseled me that palliative care was likely the next step, I knew what she was saying.

In my mother’s case, she had been directed home from the hospital because there was, n the doctor’s words, “nothing else we can do for her.” In plain and simple terms, a hospital is medically defined as the place where people go to “get better.” When it is determined by the hospital that a mission of that order is not likely to be fulfilled, families are often asked to move their loved ones to another facility, or to simply take the patient home. Hospitals do not like it when people die under their care. It does not look good on the record sheets.

My mother was consigned to palliative care following an attempt at chemotherapy to treat her pancreatic cancer. The treatment was too hard for her to take. It put her in the hospital for a few days. Then the doctor came by and told me that they were done treating her. She was able to get home and we hired caregivers. All our family visited during a three-day period and she was happily able to see nearly all her loved ones.

But then she had a stroke on a Sunday evening, and by Monday morning, the case was clear. Her ability to swallow had been destroyed. The decision to enter hospice care was defined by that condition. Within a week of entering hospice, she passed away peacefully at home. Her husband and immediate family were there with her. And while it was sad to know that she was gone, there was great closure and peace that came from that.

Hospital business

Hospitals try to avoid keeping patients until they die. It’s simply bad for business. And hospitals are a business. That does not mean hospitals can necessarily avoid death in their patients. Plenty of people die in their hospital beds. Death is simply unavoidable when the human body and mind have had enough trouble dealing with pressure and failure.

Life comes to an end in one of three ways; natural, unnatural or somewhat assisted. A natural death is what we all seem to desire. That’s when people pass away of so-called natural causes. That would be heart failure in many cases, or other organs. There are many ways to die.

An unnatural death is typically the product of overtreatment. That would be too many surgeries in many cases, and not enough energy to recover. From what I’ve read, that process and occurrence is an all-too-frequent occurrence in the American health care system.

Perspectives 

I’ve watched my own family members anguish over the merits of yet another surgery for my father-in-law. Deep down I knew it was fruitless. But the patriarch of a family is not something people give away easily. Never mind that he’d already skirted death when he collapsed face first into a pile of sawdust while sawing wood in his own backyard. His wife woke him up that day. But from there, it turned into a series of heart operations, kidney problems, weight loss and finally death in the hospital. None of that was an easy choice for the family to make. It was deemed necessary as long as he was alive, to keep him alive. But whether it was absolutely necessary to keep him alive was the question everyone avoided.

Almost all families face that type of decision sooner or later. No one said dying is easy. But we tend to make it much harder than it should be.

Prayers for dad

My father passed away in a hospital bed six months ago.  He had fallen in the middle of the night and broken his hip. His caregiver called emergency for the umpteenth time and they carted my dad off to the hospital.

Everyone knows that a broken hip is a tough injury for any elderly person to sustain. My father already had an injured arm from a previous accident. But mostly he’d had a long time dealing with the effects of a stroke suffered back in 2003. He outlived my mother by ten years and we kept him in his own home with caregivers. The diagnosis to do surgery was his decision.

The diagnosis to do surgery for the broken hip was his decision. I let him make it because even though I was an executor of his estate with Power of Attorney for health care, he was still lucid and capable of deciding for himself whether to live with a repaired hip or die from the effects of the injury.

He lived another four days and saw all four of his sons during that week. Then he passed away quietly in that hospital bed. I arrived on a Saturday afternoon to a room with quiet music playing. His blanched figure with open mouth lay on the hospital bed. I kissed his forehead as I had done many times in fifteen years of taking care of him. Then I knelt and said a prayer next to him even though he was not necessarily a praying man.

I thanked him for his love over the years even though he lost his ability to say it. I said thanks to what I know of God for believing in my ability to take care of my father. It was tough as hell, and definitely worth it.

He was dead, but his memory just as surely came alive in the days that followed. There was nothing medically I could have done to change that outcome. There seldom really is. Death comes because it is meant to be. It gave me peace to know that he no longer had to live without his voice, and his golf clubs, and that wandering spirit squelched by his confinement to a wheelchair all those years. He dealt with it pretty well, and like an SOB at times.

The art of dying

But he dealt with it. And it was our job now to deal with his passing. It all took so long and happened so fast. That’s how death works, after all. And sometimes you should not fight it. That is the art of dying.

There’ll come a time when all your hopes are fading
When things that seemed so very plain
Become an awful pain
Searching for the truth among the lying
And answered when you’ve learned the art of dying

––George Harrison, The Art of Dying

 

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As the crocus petals fall

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A close friend has been at the hospital the last few days tending to his mother. She injured herself severely in a household fall by tripping on a braided rug that her husband has long refused to throw out in their bedroom.

Such are the vagaries of old age, and sentiment. Her broken ribs and swollen brain are being treated at the hospital, but she’s not sure it’s a good idea to go on. There is fear, and there is pain.

Her son is also in pain, of the emotional kind. There has been no more faithful a son than he. For two decades he has tended their garden. Mowed their lawn. Taken them to church when necessary. His own life is intertwined with that of his parents. Because he cares.

And because he cares, he is suffering now at the thought of his mother’s passing. She is alive, but barely. Sooner or later most of us go through this experience with a parent. A spouse. Or a friend.

I know people that have even lost children. Such abrupt dissolutions.

Crocus

As I entered the house today, I glanced down to notice that the crocus in the front garden are already starting to drop their petals. We wait all winter for the first signs of spring. Then spring comes and sheds these bright signs of life as if they did not matter at all.

I have watched my mother die. I was there when she passed away 10 years ago. Recently I watched my father die as well. We emptied their house this past week. Filled a three-yard dumpster with all their former belongings. Kept a few keepsakes and practical items for our own.

My brother said, “I’m going home to get rid of 25% of what I own. If this is what happens to us when we die, I don’t want that.”

Time passes

Three years ago this March 26 my wife passed away after an eight year go-round with cancer. She lived fully right to the moment she passed away. I have always said that I am proud of her for that. But life itself sheds its hold on us like petals on a crocus.

We are reminded of all this come Easter time. According to Christian tradition, even the Son of God shed those petals of life here on earth. The faith holds that our souls are borne into heaven if we have accepted the grace, and shed the brand of pride that prevents it.

Instead, we should hold pride in the mercies we can show others. I told that to my friend, the selfless man that has cared for his parents all these years. “You are in pain because your love is wrapped together with her life. That is pain your have earned through caring. God knows that we feel that pain, and it’s the knowledge that we are loved that sustains us through it.”

Walking right into the pain

Three years ago on Good Friday, I walked into the church I attend with tears barely concealed behind my eyes. My brother asked me why I attended the service so soon after the death of my wife, and I told him, “I’m walking right into the pain.”

That’s really the only thing we can do. You can’t escape it by walking around. It follows you like a shadow. And when I walked up to meet the pastor for a blessing that Friday evening, he was the one shedding tears in my family’s name. “You are in the right place,” he told me.

That does not cure it all. There is still the absence and the loss. The profound depression knowing that someone is gone, for good. That is grief. It must be reckoned with as well. But first we must acknowledge the pain. All else is folly. That can take time. It cannot be rushed. Yet neither can we dwell in the past, lest we forget there is life to be lived.

Preaching to the choir

I understand that church is not for everyone. I get that more deeply than you might think. My own father relinquished his churchgoing ways. He loved the camaraderie of the choir, but the words ultimately didn’t mean that much. It doesn’t mean he did not have a soul. And I do not worry for it. That is not the brand of faith to which I ascribe.

We are all flawed people, who need forgiveness for the things we do. And, we should do all the forgiving we can muster. Because the real purpose of those falling petals should be to let go the lies, and the hurts, the harsh words and the lost opportunities to say that we love someone.

That is the faith to which I ascribe. It is ultimately transcendent, even in all its fallen glory. It is not keeping the crocus past its time, but knowing that its coming and going is the real sign of hope, and of caring, and of things planted for the right purposes.

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Go naturally

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photo (33)A few weeks ago I attended a live music show led by my sister-in-law’s boyfriend Tom, a professional guitarist with a really good voice who performs with a crackshot bunch of horn players. Midway through the show the band played a couple numbers by the 60s group Blood, Sweat and Tears. One of the guest singers absolutely nailed the BSWT song, “God Bless the Child,” but there was another song running through my head the rest of the night. It’s a tune called And When I Die that was a part of the amazing lexicon of music produced in the late 1960s. The lyrics start like this:

I’m not scared of dying
And I, don’t really care
If it’s peace you find in dying
Well then, let the time be near

If it’s peace you find in dying
Well then dying time is near
Just bundle up my coffin
‘Cause it’s cold way down there
I hear that it’s
Cold way down there, yeah
Crazy cold, way down there

As a kid of 12 or 13 at the time, those were odd words to read. At that point in the life, the idea of dying was so mysterious, and most of the deaths of grandparents had happened before I even arrived on earth. My mother’s parents were both gone years before, and my father’s mother too. They were ghosts, essentially, about which people did not even talk all that much. It spooked me to think about anyone dying, for these reasons. But there was some strange hope in the song with the lyrics Go Naturally as well..

And when I die, and when I’m gone
There’ll be, one child born
In this world
To carry on, to carry on

Many years passed before anyone close to me died. I lost a classmate from college track who became too dehydrated from having a cold while competing in track. His fever shot through 107-degree mark and he passed away in his room.

During that time of life (and like so many young people) I was grappling with the meaning of my faith, and whether it existed at all….

Now troubles are many
They’re as
Deep as a well
I can swear there ain’t no Heaven
But I pray there ain’t no hell
Swear there ain’t no Heaven
And I’ll pray there ain’t no hell
But I’ll never know by livin’
Only my dyin’ will tell, yes only my
Dyin’ will tell, oh yeah
Only my dyin’ will tell

I had my own brush with possible death as early as my freshman year in college. Someone made a punch for the cross country team party and it nearly cancelled my liver that night. I could easily have died of alcohol poisoning. And what a waste that might have been. So much life left to live…

Give me my freedom
For as long as I be
All I ask of livin’
Is to have no chains on me
All I ask of livin’
Is to have no chains on me
And all I ask of dyin’ is to
Go natrually, only wanna
Go naturally

Through the mists of the years I learned that sadness and anxiety and depression could be scary things, but not as scary as giving up. On the few occasions when I felt like life was too much to bear, my mind considered what it would be like to end it all. But there was no motivation to do so. Perhaps my personal faith really did have a purpose.
Here I go!
Hey hey
Here come the devil
Right behind
Look out children, here he come
Here he come, heyyy

Don’t wanna go by the devil
Don’t wanna go by the demon
Don’t wanna go by satan
Don’t wann die uneasy
Just let me go
Naturally

Then came middle age, and the challenge of managing a parent through the final year of her life. My mother died at age 80 in 2005. I was there when she passed away. Sitting inches from her bed, I could see that the week she spent in hospice was the right thing to do. She had experienced a stroke after a try at chemotherapy and her body was done with this world. That was so clear that my mourning was rich with that knowledge. It strengthened me to know that dying is in many ways not the end we all dread. It is a part of life.

And when I die, and when I’m dead
Dead and gone
There’ll be
One child born, in our world
To carry on, to carry on

That same year my wife was diagnosed with cancer, and I can tell you that scared the ever living daylights out of me. More than dying, cancer was a ghost of dastardly proportion. And yet we helped her survive through bout after bout of chemo, and our personal faith delivered small miracles that added up to one big miracle. She was still here. She had not yet died.

But after eight years her body was also through dealing with the rolling effects of chemo and surgeries and stress. I was sitting with my two children in our living room when she passed away. And days later, an astronomy student friend of my daughter staying over at our house to keep us company awoke in the middle of the living room in the middle to the sight of three floating orbs of light right at the spot where my wife had lay when she died.

There was nothing frightening about this to us. This was no hooky spooky ghost or something imagined by my daughter’s friend out of fear of death. This was a person with the mind of a scientist witnessing something beautiful and wondrous being the sphere of human imagination.

You can doubt us if you like. Or you can wonder aloud to yourself if what we see day by day is everything we can possibly know. There’s more than one way to go naturally, you see.

A few months before my wife died her own father died in a hospital bed. My wife raised herself from a cancer surgery two days after recovery and we made the trek to visit her father. The look they exchanged upon greeting each other was beyond the realm of language to describe. It was an eternal connection, something made from the fabric of time itself. A few days later, having seen that his own daughter had survived her surgery, her father passed into eternity itself.

And this past week my father died of ultimately natural causes. He was a stroke survivor for thirteen years. His four sons all visited him the last week of his life, and when his youngest had made a visit to the hospital one more time, my father passed quietly into death that afternoon.

The hospital called to tell me the news and I made the trip up to sit with my father in his room. I had a good, long cry at his bedside before kneeling down to say the Lord’s Prayer. He was no longer a praying man himself, I think he would have told you. But he said many prayers in other ways over the years.

Which leaves more than one more child to carry on. To go naturally is the greatest gift of all. Even if there are bumps and sways and difficult operations along the way, in the end we all go naturally. Death is part of life. It teaches and it cajoles. It offers us an ending to consider, one that we may try to write a little differently, and delay indefinitely, but it will come eventually.

Let’s admit this is not a bad thing. The enigmatic lead character in the movie the Green Mile is both blessed and cursed to live on, perhaps into eternity, watching his loved ones and found ones all pass away before him. He cannot go naturally into the night. He is given a glimpse of the burden of God and Christ himself. There is great love in that, but also a burden to care.

Which is why people speak of going to their final resting place. A good rest will often do you good. We may not know what comes in the great beyond, but what we know of getting there is enhanced by the fact of our very ephemeral being. It is ours to go naturally through our days, and love life in every way we can along the way.

appreciate what love means, God is love

The 10 ways I’ve most changed since I was a kid

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This morning while pouring cereal into the bowl, the box of Maple Pecan flakes ran out. Seeking to fill the dish, I picked out the Ginger Granola and poured it into the bowl to create the right portion. Then I thought, “I’d never have done that as a kid.”

Growing up I liked my cereal pretty much homogenous. If it was Cheerios or Rice Krispies, that’s what went in the bowl. Never would I think of mixing the two.

I also had a favorite spoon with which to eat my cereal. It had a raised image of the United States Capitol building on it. I loved that spoon, and ate my cereal with it every day.

These little moments of recollection set me thinking about how many other ways a person changes from a child to a grown up. At one point my own son at eight years old confessed that he would rather not grow up. He could see that being a grownup came with all sorts of challenges that did not seem to be that much fun.

And yet, there are some things that you do and feel as a kid that are not that great either. Here is a list of my Top 10 ways I’ve most changed since I was a kid. Perhaps you can share a few of your own in the comments below.

  1. No longer afraid of the dark. At some point in my late 30s I was running down the dark stairs to our basement and realized that the haunting feeling of fear at entering a dark space was no longer there. No boogeyman. No devil. No ghosts or other imagined dangers in the dark. It was a liberating feeling.
  2. Sex is no longer such a mystery. I can remember having sexual feelings very early in life. Children do, but they often don’t know what to do with them. Most masturbate their way through puberty and early teens, then experiment their way with sexual partners into some form of knowledge. It took me a long time to understand anything about sex, and that is not to say I know all about it now, either. But the giant wall that was “sex” looming ahead in life from the perspective of childhood was quite difficult to figure out. I was always jealous of kids who seemed to know so much about sex. And some just did. It’s a gift, I guess.
  3. My sense of wonder is not the same. This is both a relief as a person, and a shame as well. As a very sensitive child there were many moments of experience so deep and heartfelt it was difficult to function at times. I recognize now that some of this was tied to an anxious mind. Gaining control of my ruminative nature has been necessary to function in this world. And yet, I sometimes miss the intensity with which I felt a keen sense of wonder at nature, or in a moment.
  4. My trusting nature has evolved. I still trust people, especially those I love. But through many experiences in life, one learns that some people simply cannot be trusted. That was not me as a child. I trusted everyone. I often got teased or tricked as a result. The long journey to loss of naivete is the hardest road many of us travel in life.
  5. Money is just something, where it was once everything. As a kid you’re happy as heck to have money to buy candy or cheap stuff to entertain yourself. Our acquisitive nature drives us to want way more than we need. We obviously need money to survive in this world, and one learns through odd jobs and real jobs that you have to work hard to earn it. Some people judge themselves (and others) by what they earn. They see it as a mark of adulthood. And that is to some degree true. But there’s also an immature or childish nature to liking money too much. The Bible warns us that the love of money is the root of all evil. It is also the mark of adulthood to balance your love of money with gratitude in life.
  6. I put competition in perspective. For some crazed reason I could not stand to lose as a kid. Hated it. As an athlete I became one of the most competitive people you could meet. My brothers called me The Mink because I’d get spitting mad in the heat of competition. That fire to win served me well for the most part, winning races as a runner and leading the teams on which I competed or coached to victories. But at some point I recognized that the desire to win must be tempered with the understanding of what it really means to win, and when winning actually represents some sort of loss. Because that can happen in relationships, for example. But I have always, always fought for the underdog and for fairness to the best of my ability. I’m proud that I have not changed or lost that childhood sense of fair play to this day.
  7. I’ve learned to forgive myself. In my case childhood essentially lasted through the age of 29 years old. That’s when I woke up pounding the pillows in anger over some of the things that happened in my upbringing. I was confused by these angry feelings all through my teens and 20s. As I began to understand their source and grow out of the vexing events so many of us experience in childhood, it became evident that I was beating myself up all the time by not being willing to forgive those who might have wronged me. But it was a wise counselor that finally asked me this question: “You seem to be good at forgiving others…how are you at forgiving yourself?”
  8. My sweet tooth really is my enemy. We all want candy without the consequences. Back home in Lancaster, Pennsylvania there was a candy store a quarter mile from our home. A dollar would buy you tons of sweets, and that foundation of candy-loving carried through my college years and well into adulthood. But the harsh truth is that sweets are bad for your body in a lot of ways. Between sugar and carbohydrates, the supposed fuel of athletes, there lies deep danger to your heart, stomach, liver, kidneys and other organs. Reigning in my sweet tooth is hard, but it truly is the sign of a wise adult.
  9. Love has changed me. For all the flaws we see in our parents as we grow up, it often takes a lifetime to appreciate how they loved you. I no longer have any doubts about that, even with my father, who at times was a hard and exasperating man to abide. Time has given me insight into how many ways he did nurture me, and my mother too. As a result, love has changed me from a child who felt hurt due to a sensitive nature into a man who is sensitive to the power of love to heal those emotional pains. I’ve also grown in my understanding of faith from a child taught through bible stories to think of heroes as outsized personalities to a person who sees heroics in the small and wonderful things people do for each other. That is true love.
  10. Death is no longer so scary. Dead things were always both interesting and scary as a kid. The only funeral I attended as a child was for some relative I knew little about. It reduced me to tears seeing my aunt and uncle cry at the loss of their loved one. Yet when I lost a treasured former teacher to a heart attack in 1993, the funeral turned out to be a celebration of his life. I learned from that. Then my mother passed away in November 2005, and I was there when she ceased breathing and I saw that her body was through with life. Of course, during the eight years in which my wife struggled through cancer treatment, death was the frightful thing that always lurked ahead. When it came to us n March, 2013, my next worries were how to help my children deal with the loss of their mother. That is a challenge that will never abate. I think about my own mortality as well, and if you do the math and add up the years you have remaining on this earth, life itself can seem pretty scary.

So how delightfully ironic it is, that one of the best ways we can learn to enjoy life is to bring back our inner child. That’s when we begin to experience life in new and meaningful ways. It doesn’t mean you need to relinquish all the things that you’ve earned for yourself as a healthy adult. It may mean setting aside some of your more restrained behavior so that you can try new things, take chances and live a little. Or a lot.